Provider Demographics
NPI:1982454989
Name:GILLERLAIN, MADISON E
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:E
Last Name:GILLERLAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BALMORAL CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1380
Mailing Address - Country:US
Mailing Address - Phone:302-388-4427
Mailing Address - Fax:
Practice Address - Street 1:107 WOODLAND RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-2871
Practice Address - Country:US
Practice Address - Phone:412-365-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist